Risk factors for autism spectrum disorder diagnosed in Indonesia

Background. Autism spectrum disorder (ASD) is a complex neurodevelopmental condition influenced by both genetic and environmental factors, with epigenetic mechanisms playing a central role in gene regulation. Early identification of risk factors is essential for timely intervention, particularly in children aged 1–3 years when diagnosis remains challenging. Materials and methods. This case-control study aimed to identify prenatal, perinatal, and postnatal factors associated with the incidence of ASD in young children. A total of 156 participants (79 with ASD and 77 controls) aged 1–3 years were enrolled from Dr. Soetomo General Hospital. Data were collected from medical records and structured parental interviews, covering variables such as maternal health, birth history, family background, socioeconomic status, and environmental exposures. Results. Statistical analysis using bivariate and multivariate logistic regression identified several significant risk factors. These included male gender (odds ratio (OR): 5.634, p = 0.011), being the youngest child (OR: 4.022, p = 0.023), lack of maternal folic acid supplementation during pregnancy (OR: 15.265, p = 0.032), history of premature rupture of membranes (OR: 28.401, p = 0.006), and screen time exceeding one hour per day (OR: 47.356, p < 0.001). Additionally, lower maternal education level and residence near industrial areas were associated with increased ASD risk. Conclusions. These findings highlight the multifactorial etiology of ASD and the importance of modifiable prenatal and postnatal factors. Promoting maternal education, prenatal care, folic acid supplementation, and reducing early screen exposure could help in ASD prevention strategies. Further research is needed to explore underlying mechanisms and validate these associations in larger populations.